MEDICARE: KATIE FREDERICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0704013810	VA

General Provider Information

NPI Number	:	1891492054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE FREDERICK

Provider Business Mailing Address
First Line	:	8769 HUGHESLAND RD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2900
Country	:	US
Telephone Number	:	804-387-7519
Fax Number	:

Provider Business Practice Location Address
First Line	:	2807 N PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23294-4410
Country	:	US
Telephone Number	:	804-387-7519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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